| Entity Name: | JOSEPH F CONDON, MD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Apr 2021 (4 years ago) |
| Date of dissolution: | 27 Sep 2024 (4 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (4 months ago) |
| Document Number: | P21000041076 |
| FEI/EIN Number | 86-3728528 |
| Address: | 3417 Tamiami Trail, Port Charlotte, FL, 33952, US |
| Mail Address: | 3417 Tamiami Trail, Port Charlotte, FL, 33952, US |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972278042 | 2021-08-11 | 2024-10-04 | 3417 TAMIAMI TRL STE A, PORT CHARLOTTE, FL, 339528158, US | 3417 TAMIAMI TRL STE A, PORT CHARLOTTE, FL, 339528158, US | |||||||||||||||||||||||||
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| Phone | +1 978-440-0380 |
| Fax | 8773495062 |
Authorized person
| Name | JOSEPH F CONDON |
| Role | OWNER |
| Phone | 9416265291 |
Taxonomy
| Taxonomy Code | 2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | ME148837 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CONDON JOSEPH F | Agent | 1620 NUREMBERG BLVD, PUNTA GORDA, FL, 33983 |
| Name | Role | Address |
|---|---|---|
| Condon Joseph F | Owne | 3417 Tamiami Trail, Port Charlotte, FL, 33952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-11-08 | 3417 Tamiami Trail, UNIT A, Port Charlotte, FL 33952 | No data |
| CHANGE OF MAILING ADDRESS | 2022-11-08 | 3417 Tamiami Trail, UNIT A, Port Charlotte, FL 33952 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-12 |
| Domestic Profit | 2021-04-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
